This document summarizes a study that explored factors contributing to patient overcrowding in the emergency department at King Saud Hospital in Unaizah, Saudi Arabia. The study found that the main factors were a lack of human resources, high population density, lack of beds, issues with public health awareness, and problems with emergency department design. A survey of 168 medical professionals at the hospital identified health awareness as having the highest impact and lack of beds as having the lowest impact on emergency department overcrowding. The study recommends strategies like increasing staffing levels and space in the emergency department.

1. Journal of Natural Sciences Research
ISSN 2224-3186 (Paper) ISSN 2225-0921 (Online)
Vol.3, No.13, 2013
www.iiste.org
Contributing Factors to Patients Overcrowding in Emergency
Department at King Saud Hospital Unaizah, KSA
Ayed Awadh AL-Reshidi
B.S of pharmacy, MBA, CHS, BB in Lean &Six Sigma, Quality And Risk Management Director In King Saud
Hospital Unaizh, KSA
Email: ai.ed@hotmail.com
Abstract
Emergency department (ED) crowding represents an international crisis that may affect the quality and access of
health care. The aim of this study was to explore contributing factors to patients overcrowding in the emergency
department at King Saud hospital, Saudi Arabia. Research design: descriptive analytical. Tool for data
collection: questionnaire to explore contributing factors to patients overcrowding in ED. Setting: King Saud
Hospital Unaizah, KSA. Sample: stratified random sample (168) subjects including nurses, physicians,
technicians and administrators. Results: the following factors contribute to overcrowding in emergency
department: lack of human resources; population density; lack of beds; health awareness; and emergency
department design. The respective means of these factors are: 3.91, 3.72, 3.65, 4.27 and 3.95. Conclusion:
Based on the results of the present study, it was concluded that the domain that has the highest effect on patient
overcrowding in ED is health awareness domain. However the domain that has the lowest effect on patient
overcrowding in ED is lack of beds Recommendations: the development of standards to work in the emergency
department. Create a sort of cases. Increasing the numbers of doctors and nurses in emergency department,
review of the shift system currently used and provide additional space for the ED.
Keywords: contributing factor, emergency department, patient overcrowding
1. Introduction:
The emergency department (ED) is one of the important departments of the hospital. ED role is based mainly on
receiving emergency cases that require fast and immediate treatment to reduce the risk of emergency situation on
the patient, and make him in a better condition to receive another level of treatment (Albakry, 2005).
The emergency department is a core clinical unit of a hospital. The experience of patients attending the
emergency department significantly influences patient satisfaction and the public image of the hospital. ED
function is to receive, triage, stabilize and provide emergency management to patients who present with a wide
variety of critical, urgent and semi urgent conditions whether self or otherwise referred. The emergency
department also provides for the reception and management of disaster patients as part of its role within the
disaster plan of each region (Australian College for Emergency Medicine, 2007).
Patients who present at an emergency department are usually seen in order of need, not in order of arrival. This
process ensures the sickest and most urgent patients are seen first. On arrival, patients are assessed by a nurse or
doctor, who decides how urgent their problem is and how soon treatment is required. This assessment and
prioritization process is known as triage. Patients are then seen in order of the seriousness of their condition.
Once assessed and treated by ED staff, patients may be admitted to the hospital, transferred to another hospital or
discharged (New Zealand Ministry of Health, 2011).
In addition to standard treatment areas, some departments may require additional specifically designed areas to
fulfill special roles, such as: the management of pediatric patients, the management of major trauma patients, the
management of psychiatric patients, the management of infectious patient, the extended observation and
management of patients, the management of patients affected by chemical, biological or radiological incidents,
undergraduate and postgraduate teaching (Australian College for Emergency Medicine, 2007).
ED overcrowding refers to the situation where ED function is impeded primarily because the number of patients
waiting to be seen, undergoing assessment and treatment, or waiting for departure exceeds either the physical
bed and/or staffing capacity of the ED. Overcrowding of patients in ED is associated with diminished quality of
care and poor patient outcomes. These include, but are not limited to, adverse events, violent behavior, errors,
delayed time to critical care, increased morbidity and excess deaths (Australian College for Emergency Medicine,
2011).
Multiple factors are likely contributors to the growing crisis of ED crowding. These factors are: unnecessary ED
patient visit; Frequent flyer patients ; the inability to transfer emergency patients to inpatient beds and the
resultant boarding of admitted patients in the ED for long periods; use of the ED for nonemergency complaints;
shortage of ED staff, lack of beds and inappropriate ED use (Moskop, 2009).
Factors contributing to emergency department overcrowding can be categorized as external factors and internal
factors. External factors are: limited access to primary care, a growing elderly population, inadequate access to
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2. Journal of Natural Sciences Research
ISSN 2224-3186 (Paper) ISSN 2225-0921 (Online)
Vol.3, No.13, 2013
www.iiste.org
inpatient and outpatient health services, high rates of uninsured and underinsured, ED closures. The Internal
factors include: lack of access to on-call specialists, variation in surgical schedules with more elective
procedures scheduled for earlier in the week, ED boarding, inefficient discharge and bed-turnover process,
inefficient registration process (Lee,2013).
EDs are high-risk, high-stress environments. When capacity is exceeded, there are heightened opportunities for
error. The six dimensions of quality (safety, effectiveness, patient-centeredness, efficiency, timeliness, and
equity) may all be compromised when patients experience long waits to see a physician, patients are boarded in
the ED, or ambulances are diverted away from the hospital closest to the patient. Over the past few years, several
studies have presented clear evidence that ED crowding contributes to poor quality care and patient mortality. A
crowded ED also limits the ability of an institution to accept referrals and increases medico legal risks (McHugh,
2011).
Markers of ED overcrowding include: inability to offload ambulance patients and a resultant loss of capacity in
the local emergency response in the community; inability to place critically unwell patients in an appropriate
treatment space when required; Patients undergoing clinical management in a non-treatment area, where privacy,
and access to basic clinical resources is reduced or delayed; Admitted patients receiving a lesser standard of care
than they would receive in their destination unit; Obstruction to access and egress routes from the ED, in
contravention of Occupational Health and Safety requirements(Australian College for Emergency Medicine,
2011).
Potential solutions for ED crowding include: Provide after-hours clinic care; establish a nurse hotline to address
patients' health concerns to avoid ED visits for non emergent needs; enhance post-discharge follow-up
procedures with certain patient populations to avoid unnecessary readmissions. Provide physician triage in the
ED; Build a point-of-care testing satellite laboratory; Establish a fast-track system that allows non urgent
patients to be treated faster by providers other than physicians; Establish an observation unit to move patients in
need of short hospitalization; Offer preferred operating room times to specialists for on-call coverage. Move
patients from the ED immediately after admission; Optimize operating room scheduling; Hire a bed czar to
oversee the timely, appropriate transfer of ED patients to inpatient areas; Create a discharge lounge for patients
who are ready for discharge, but are waiting for medications, transportation or education, Coordinate the
discharge of inpatients before noon; Create an intermediate ICU to increase ICU capacity (Lee, 2013).
Significance of the Study
The emergency department is considered to be the core unit in the provision of service to patients in the health
care system. It provides a wide variety of medical services for patients with urgent cases e.g. injuries and trauma.
Due to the nature of the services that the department provides, the department receives daily a large number of
patients which causes crowding and results in negative effects on patients' safety, quality of care, and the
hospital. Therefore, it is important to explore the factors that contribute to patients overcrowding in ED at King
Saud Hospital Unaizah, AlQassim, KSA.
Aim of the study:
To explore contributing factors to patients overcrowding at ED at King Saud Hospital Unaizah, AlQassim, KSA.
Research question:
What are contributing factors to patients overcrowding at ED at King Saud Hospital Unaizah, AlQassim, KSA?
2. Subjects and Method
2.1. Research design : A descriptive analytical research design was conducted for this study.
2.2.
Setting: The study was conducted at King Saud Hospital Unaizah, AlQassim, KSA. It is The only
tertiary care hospital in the Governorate. This hospital has 360 beds and provides service to the community
through the following units and departments: ICU, CCU, NICU, pediatric ICU, burn unit, OR, dialysis, Surgical,
medical, emergency, and obstetric departments
2.3.
Sample: population at King Saud Hospital Unaizah, AlQassim, KSA include physicians, nurses,
technicians, and administrators their total number was 892 persons at the time of study. Stratified random
sample of 200 subjects is taken from the above mentioned population. 200 questionnaires were distributed on the
sample but 168 questionnaires were completed and returned back with response rate 84%. The 168 subjects of
the sample consist of 24 physicians, 86 nurse, 43 technicians, and 15 administrators.
2.4. Tools for data collection:
Based on review of literature and previous studies the researcher designed questionnaire to study factors
affecting patient overcrowding in ED. The questionnaire consists of two parts:
Part I: Questionnaire for socio-demographic data: it contains the personal data (gender, nationality, age,
educational level, years of experience in the current job, and job title)
Part II : this part has 30 items. It was allocated to identify the factors affecting patients' crowdedness in the ED.
This part has five domains which are:
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3. Journal of Natural Sciences Research
ISSN 2224-3186 (Paper) ISSN 2225-0921 (Online)
Vol.3, No.13, 2013
www.iiste.org
1- The lack of human resources ( items from 1 to 10)
2- The population density ( items from 11 to 16)
3- The lack of beds in the ED (items from 17 to 22)
4- Health awareness (items from 23 to 26)
5- The ED design (items from 27 to 30)
The responses were on a 5- point Likert scales ranging from strongly agree to strongly disagree. For each domain
the responses of strongly agree, agree, not sure, disagree, and strongly disagree were scored 5, 4, 3, 2, and 1
respectively. The scores of the items were summed up and the total divided by the number of items, giving a
mean score for the part. These scores were converted into a percent score.
2.5. Administrative design:
Before starting the actual data collection process administrative approval for the research was taken from
director of the hospital.
2.6. Validity and Reliability
Face validity and content validity test was done by expert opinions to ensure that the items of the questionnaire
test what is designed to test. Reliability test was done by applying Cronbach alpha test
2.7. Pilot study:
A pilot study was conducted on 10 subjects from King Saud Hospital Unaizah, AlQassim, KSA to test the
applicability and clarity of the tool and to estimate the time needed to fill in the questionnaire. On the basis of the
pilot study result the researcher determined the feasibility of data collection procedures, subjects who had
participated in pilot study were excluded from the sample during data analysis.
2.8. The Field Work
Data collection was carried out within duration 3 months in first semester 1432/1433. The time required for
completing the questionnaire was ranged from 15 to 20 minutes.
2.9. Protection of Human Rights:
The researcher informs the subjects that all information would remain confidential. And used only for the
purpose of research. The purpose of the study was explained and subjects were informed that they have the
freedom to accept or reject participation at any time, without any prejudice.
2.10.
Statistical Analysis:
The collected data was analyzed and tabulated using the statistical package for the social sciences (SPSS).
Qualitative data was analyzed through numbers and percentages. Quantitative data was analyzed using
Arithmetic mean and standard deviation. Chi square was used to test statistical significant differences between
qualitative data.
Results
Table (1) percentage distribution of study subjects according to socio-demographic characteristics.
Socio-demographic characteristics
Study sample (N=168)
No
37.5
62.5
56
112
33.3
66.7
8
78
70
12
4.8
46.4
41.7
7.1
12
86
43
15
12
Job title
Physician
Nurse
Technician
Administrators
Others
Age:
˂ge:rsstra
30 – 45 years
˃0 – 45 yea
%
63
105
Sex
Male
Female
Nationality:
Saudi
Non Saudi
Education:
Secondary school
Health college
Baccalaureate
Postgraduate
7.1
51.2
25.6
8.9
7.1
35.7
57.2
7.1
60
96
12
Years of experience
˂ears of experience)a
˃–ars of ex
29.2
63.1
7.7
49
106
13
Table (1) shows percentage distribution of study subjects according to socio-demographic characteristics.
According to this table, majority of study subjects are female, non Saudi, have health college education and
nurses. Also, their ages ranged from 30 – 45 years and their years of experience ranged from 5– 15 years.
Table (2) percentage distribution of study subjects according to scores of human resource shortage.
Human resource shortage
Study subjects
(N= 168)
35
Chi
square
P- value

4. Journal of Natural Sciences Research
ISSN 2224-3186 (Paper) ISSN 2225-0921 (Online)
Vol.3, No.13, 2013
www.iiste.org
Agree
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Not sure
Disagree
No
96
%
57.1
No
60
%
35.7
No
12
%
7.2
87.5
.007
136
122
80.9
72.6
23
20
13.7
11.9
9
26
5.4
15.5
153
135
.001*
.001*
100
59.5
44
26.2
24
14.3
172
.002*
102
60.7
40
23.8
26
15.5
72
.007
143
85.1
13
7.7
12
7.1
133
.001*
76
45.2
41
24.4
51
30.4
56.2
.007
113
67.3
22
13.1
33
19.6
84
.006
158
94
3
1.8
7
4.2
325.6
.001*
70
Shortage of medical staff specialized in emergency
medicine.
Shortage of nursing staff specialized in emergency.
Long time consumed in laboratory, radiology and other
procedures.
The physician documentation process for patients which
leads to consuming a long time in the examination
process.
Emergency department don`t adopt the initial examination
process.
The hospital admits large number of patients regardless of
its possibility.
Inability of the hospital to predict the numbers of patients
who come to emergency.
Records and forms used in recording admission of patients
are multiple and diverse leading to confusion.
Emergency department staff (Nurses and physicians) feel
stressed due to their shortage and large number of patients.
Lack of coordination between workers in emergency
department.
41.7
55
32.7
43
25.6
33.3
.008
*statistical significant difference p ˂ .05
Table (2) presents percentage distribution of study subjects according to scores of human resource shortage.
There were statistical significant differences in the following factors that affect overcrowding of patients:
shortage of nurses specialized in emergency, long time consumed in laboratory, radiology and other procedures,
physician documentation process which leads to consuming a long time in the examination process, The hospital
admits large number of patients regardless of its possibility and Emergency department staff (Nurses and
physicians) feel stressed due to their shortage and large number of patients. Majority of study subjects (94%)
agree that emergency staff stress affects overcrowding of patient.
Table (3) percentage distribution of study subjects according to scores of population density.
population density
Agree
No
%
1.
2.
3.
4.
5.
6.
Large increase in the percentage of patients due to
accidents
like
burns,
electric
shock,
poisoning ……etc.
Escalating increase in the number of injured as a
result
of
traffic accidents.
Increase in the percentage of the diseases
associated with atherosclerosis, heart attack and
neurological diseases.
Increase in the percentage of the injured in the
work places due to lack of occupational safety
measures.
Lack of the practice and application observation
medicine
(Which
classifies
patients
to
dangerous
And moderate cases) in the emergency department.
There is no schedule for a preset emergency shifts
through which physicians and nurses are called in
the time of emergency.
Study subjects
(N= 168)
Not sure
No
%
Chi
square
P- value
Disagree
No
%
104
61.9
29
17.3
35
20.8
168
.001*
125
74.4
16
9.5
27
16.1
142.9
.001*
76
45.2
80
47.6
12
7.1
110.6
.001*
102
60.7
53
31.5
13
7.7
161.5
.001*
122
72.6
28
16.7
18
10.7
96.3
.002*
98
58.3
53
31.5
17
10.1
74.7
.004*
Table (3) shows percentage distribution of study subjects according to scores of population density. There were
statistical significant differences in all items of population density. Majority of study subjects (74%) agree that
Escalating increase in the number of injured as a result of traffic accidents is a factor affecting patient
overcrowding in ED.
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5. Journal of Natural Sciences Research
ISSN 2224-3186 (Paper) ISSN 2225-0921 (Online)
Vol.3, No.13, 2013
www.iiste.org
Table (4) percentage distribution of study subjects according to scores of lack of beds
Study subjects
Lack of beds
(N= 168)
Agree
Not sure
Disagree
No
%
No
%
No
%
Chi
squar
e
Pvalue
1.
Lack of beds for patient hospitalized in 137 81.5 16
9.5
15 8.9
139.7 .001*
emergency department.
2. Small number of patient admission rooms for 98
58.3 33
19.6 37 22
74.5
.008
in emergency department.
3. Numbers of beds in the hospital are not 91
54.2 31
18.5 46 27.4
80.99 .008
enough for patient hospitalization.
4. Presence of patients in the emergency 82
48.8 49
29.2 37 22
75.4
.006
department waiting for free hospital beds.
5. Lack of material resources needed to increase 62
36.9 76
45.2 30 17.9
100.3 .002*
the number of beds in the emergency
department.
6. The continuous increase in the number of 125 74.4 40
23.8 3
1.8
66.3
.006
patients under constant the possibilities of the
emergency department.
Table (4) shows percentage distribution of study subjects according to scores of lack of beds. There were
statistical significant difference in the factors of Lack of beds for patient hospitalized in emergency department
and Lack of material resources needed to increase the number of beds in the emergency department. The highest
percentage of study subjects (81.5%) agree that lack of beds for patient hospitalized in emergency department is
a factor affecting patient overcrowding in ED.
Table (5) percentage distribution of study subjects according to scores of health awareness
Health awareness
Study subjects
Chi
P(N= 168)
square
value
Agree
Not sure
Disagree
No
%
No
%
No
%
Patients who come to the emergency 145
86.3
20
11.9 3
1.8
94.7
.002*
department and are not considered
emergency cases
2. The majority of patients coming to the 145
86.3
19
11.3 4
2.4
105.9
.001*
emergency department at Evening
times
3. Some patients interfere in the work of 122
72.6
36
21.4 8
6
109.3
.001*
the doctor and request Treatments may
not be needed for the patient
4. Some patients treat Emergency 147
87.5
6
3.6
15
8.9
100.7
.001*
Department staff in an improper
manner.
Table (5) shows percentage distribution of study subjects according to scores of health awareness. . There were
statistical significant differences in all items of health awareness. Majority of study subjects (87.5%) agree that
some patients treat Emergency Department staff in an improper manner is a factor affecting patient
overcrowding in ED.
1.
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6. Journal of Natural Sciences Research
ISSN 2224-3186 (Paper) ISSN 2225-0921 (Online)
Vol.3, No.13, 2013
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Table (6) percentage distribution of study subjects according to scores of emergency department design
Emergency Department Design
Study Subjects
Chi
P(N= 168)
Square Value
Agree
Not Sure
Disagree
No
%
No
%
No
%
1.
The difficulty of movement within the 99
58.9 38
22.6 31
18.5 38.1
.009
emergency
department
(
Current planning is not suitable for the
emergency department)
2. The inadequacy of places allocated to 136
81
9
5.4
23
13.7 149.7
.001*
waiting patients
3. ineffective use of the resources 84
50
48
28.6 36
21.4 75.5
.006
available
Emergency department
4. Lack of space allocated to the 139
82.7 20
11.9 9
5.4
91.6
.002*
emergency
department
under
continuous increase of numbers of
patients
Table (6) shows percentage distribution of study subjects according to scores of emergency department design.
There were statistical significant differences in two factors of overcrowding namely: The inadequacy of places
allocated to waiting patients and Lack of space allocated to the emergency department under continuous increase
of numbers of patients. Moreover, majority of study subjects (82.7%) agree that Lack of space allocated to the
emergency department under continuous increase of numbers of patients is a factor affecting patient
overcrowding in ED.
Figure (1) study subjects mean scores of the factors affecting overcrowding of patients in emergency
department
4.4
4.3
4.2
4.1
4
3.9
3.8
mean
3.7
3.6
3.5
3.4
3.3
human
resoure
shortage
population
density
lack of beds
health
awareness
ED design
Figure (1) shows study subjects mean scores of the domains of the factors affecting overcrowding of patients in
emergency department. According the figure the factor that has the highest effect on patient overcrowding in ED
is health awareness domain (mean = 4.27). However the factor that has the lowest effect on patient overcrowding
in ED is lack of beds (mean = 3.65).
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7. Journal of Natural Sciences Research
ISSN 2224-3186 (Paper) ISSN 2225-0921 (Online)
Vol.3, No.13, 2013
www.iiste.org
Table (7 a) study subjects mean scores of the factors affecting patients overcrowding in ED
Factors contributing to patients` overcrowding
Mean
SD
1. Shortage of medical staff specialized in emergency medicine.
3.83
1.03
2. Shortage of nursing staff specialized in emergency.
4.27
.95
3. Long time consumed in laboratory, radiology and other procedures.
3.94
1.05
4. The physician documentation process for patients which leads to consuming a long time
3.77
1.05
in the examination process.
5. Emergency department don`t adopt the initial examination process.
3.76
1.15
6. The hospital admits large number of patients regardless of its possibility.
4.39
.91
7. Inability of the hospital to predict the numbers of patients who come to emergency.
3.29
1.19
8. Records and forms used in recording admission of patients are multiple and diverse
3.76
1.26
leading to confusion.
9. Emergency department staff (Nurses and physicians) feels stressed due to their shortage
4.75
.69
and large number of patients.
10. Lack of coordination between workers in emergency department.
3.34
1.19
11. Large increase in the percentage of patients due to accidents like burns, electric shock,
3.64
1.05
poisoning ……etc.
12. Escalating increase in the number of injured as a result of traffic accidents.
3.92
1.03
13. Increase in the percentage of the diseases associated with atherosclerosis, heart attack
3.57
.99
and neurological diseases.
14. Increase in the percentage of the injured in the work places due to lack of occupational
3.67
.81
safety measures.
15. Lack of the practice and application observation medicine
3.89
.93
(Which classifies patients to dangerous
and moderate cases) in the emergency department.
Table (7 b) study subjects mean scores of the factors affecting patients overcrowding
16. There is no schedule for a preset emergency shifts through which physicians and 3.67
.96
nurses are called in the time of emergency.
17. Lack of beds for patient hospitalized in emergency department.
4.21
1
18. Small number of patient admission rooms for in emergency department.
3.77
1.26
19. Numbers of beds in the hospital are not enough for patient hospitalization.
3.37
1.22
20. Presence of patients in the emergency department waiting for free hospital beds.
3.34
.97
21. Lack of material resources needed to increase the number of beds in the emergency
3.25
.89
department.
22. The continuous increase in the number of patients under constant the possibilities of
4.01
.77
the emergency department.
23. Patients who come to the emergency department and are not considered emergency
4.32
.76
cases
24. The majority of patients coming to the emergency department at Evening times
4.37
.78
25. Some patients interfere in the work of the doctor and request Treatments may not be 4.11
.98
needed for the patient
26. Some patients treat Emergency Department staff in an improper manner.
4.28
.90
27. The difficulty of movement within the emergency department ( Current planning is 3.60
1.18
not suitable for the emergency department)
28. The inadequacy of places allocated to waiting patients
4.16
1.16
29. ineffective use of the resources available Emergency department
3.36
.97
30. Lack of space allocated to the emergency department under continuous increase of 4.30
.88
numbers of patients
Table (7 a & b) show study subjects mean scores of the factors affecting patients overcrowding. According to the
table the factor that highest mean (4.75) is Emergency department staff (Nurses and physicians) feels stressed
due to their shortage and large number of patients. However the factor that has the lowest mean (3.25) is Lack of
material resources needed to increase the number of beds in the emergency department.
5. Discussion:
Crowding occurs when the identified need for emergency services exceeds available resources for patient care in
the ED, hospital, or both.”The issue of ED crowding is not new. Early reports of crowding appeared in the
emergency medicine literature almost 20 years ago (Moskop et al, 2009). The aim of this study is to explore
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8. Journal of Natural Sciences Research
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Vol.3, No.13, 2013
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contributing factors to patients overcrowding at ED at King Saud Hospital Unaizah, Al Qassim, KSA.
The results of this study (table 2) are consistent with the findings of ( Reda & Baddar, 2006 ) who concluded
that the most important reasons that lead to the emergency department overcrowding are the human resource
shortage, administrative procedures, and increase the rate of psychological stress between both doctors and
nursing , poor communication between workers in the emergency department. Moreover, the results of this
study are in the same line with (Suzanne, 2006) who found that the main cause of overcrowding in ED is
shortage of staff, lack of coordination between staff and occupational stress. Also, this result is congruent with
(Prabath, 2010) who mentioned that time consumed in diagnosis and decision making are most important
factors leading to overcrowding of patient in ED.
The results of this study ( table 3) are congruent with (Michael, 2006) who found that decreasing the number of
patients who cases are minor and not urgent will save time also, nurses can make initial assessment and this can
lead to decrease the waiting time and decrease the crowding . The results of this study (table 4) are in the same
line with the findings of (Pines, 2008) that reveal that lack of beds affects the satisfaction of patients and lead to
increase the waiting time and increase crowding.The results of this study are congruent with (Michael, 2006)
who found that 50.9% from cases that come to ED are not emergency cases and can be treated at primary care
centers. Moreover, the results of this study revealed that other causes that can lead to overcrowding of patients in
ED are: ineffective role of primary care centers, some patients come to ED many times a day thinking that the
medication is not useful however the medication needs time to be effective, lack of population's health
awareness about the importance of ED and it should only be for accidents , injuries and other emergency cases
6. Conclusion:
Based on the results of the present study, it was concluded that the domain that has the highest effect on patient
overcrowding in ED is health awareness domain. However the domain that has the lowest effect on patient
overcrowding in ED is lack of beds. Also, the factor that highest mean (4.75) is Emergency department staff
(Nurses and physicians) feels stressed due to their shortage and large number of patients. However the factor that
has the lowest mean (3.25) is Lack of material resources needed to increase the number of
beds in the emergency department.
7. Recommendations:
In regards to the study results the researcher recommends the following:
1- The hospital administration has to establish a triage unit where cases coming to the ED are ranked so the
urgent cases are treated immediately without taking too long in the ED, and stable cases are dealt with
according to the system either let them stay for a while, or transfer them to any near primary care center.
2- The working policy in the ED should be reconsidered by making working standards suitable for the current
numbers in the ED. And this has to be through a written system for triage in which patients are sorted
according to the severity of their cases, and then receive and treat the acute cases while simple cases are
transferred to alternate primary care centers in town. This system has to be approved by the hospital
administration.
3- The hospital administration should take seriously working on increasing the number of physicians and
nurses in the ED within what matches the huge increase of patients' number received daily by
communicating with the Ministry to recruit physicians and nurses according to the ED needs.
4- The shift system currently used in the hospital should be reconsidered. so that modifications on this system
are made such as providing incentives to staff.
5- The hospital administration should take care of patients' health awareness and that can be through direct
education by meeting with the patients, distribution of brochures designed especially for this purpose, or
broadcasting educational programs on the TVs inside the hospital that may affect positively patients and
visitors behavior.
6- The hospital administration should be working on the provision of extra space and beds for the ED due to
the huge increase in patients' numbers and the narrow space of the ED.
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http://www.moh.govt.nz
4. Australian College For Emergency Medicine. (2011). Statement on emergency department overcrowding.
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Part 1—Concept, Causes, and Moral Consequences. American College of Emergency Physicians.
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9. Journal of Natural Sciences Research
ISSN 2224-3186 (Paper) ISSN 2225-0921 (Online)
Vol.3, No.13, 2013
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41

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